Page 1696 - Cote clinical veterinary advisor dogs and cats 4th

Pyoderma 853

• Subcutaneous mycoses (deep pyoderma) or Burrow’s solution (aluminum acetate of injections is gradually reduced to once
solution) daily.
weekly and then to every other week.
• Atypical mycobacterial infections (deep Systemic antibiotic therapy: ○ Extended regimens of antibiotic therapy
VetBooks.ir • Hookworm (deep pedal pyoderma) • Systemic antibiotic therapy is required to (or pulse therapy): in light of emerging Diseases and Disorders
pyoderma)
treat widespread superficial pyodermas and
multidrug-resistant Staphylococcus spp,
• Foreign-body granulomas (deep pyoderma)
deep pyodermas.
Initial Database • Bactericidal antibiotics are generally rec- pulse therapy should be considered a
last resort and should be used only with
• Skin scrapings to confirm or rule out ommended for skin infections; however, regular C&S monitoring (p. 653).
Demodex and Sarcoptes bacteriostatic drugs may be effective in an • Antimicrobial shampoo or lotions used on
• Skin cytologic exam (p. 1091): direct smear immunocompetent animal. The chosen drug a regular basis may assist in the prevention
from pustule reveals bacteria, neutrophils in should have a narrow spectrum to limit the of relapses by limiting the bacterial surface
varying stages of degeneration, and active effects on the normal flora of the skin and flora.
bacterial phagocytosis. gastrointestinal (GI) tract.
• Fungal culture (for dermatophytes and • Cases should be treated for a minimum Possible Complications
possibly for deep mycosis if draining tracts of 3-4 weeks or 7-14 days beyond clinical • Many antibiotics occasionally cause vomiting
are present) cure. Deep pyoderma may take as long as 12 and diarrhea.
weeks to resolve. Regular re-exam is recom- • Fluoroquinolones can cause cartilage damage
Advanced or Confirmatory Testing mended to minimize overly prolonged use in growing puppies.
• Culture and susceptibility (C&S) testing: of antibiotics. • Potentiated sulfonamides: keratoconjuncti-
when there has been a failure to respond • The most commonly used antibiotics (gener- vitis sicca, polyarthritis, uveitis, immune-
to rational antibiotic therapy or bacilli are ally monotherapy) include mediated dermatitis, hepatobiliary disease,
noted on skin cytologic exam ○ Cephalexin 22-30 mg/kg PO q 8-12h drug interaction, decreased thyroid function
• Skin biopsy and histopathologic exam: not (most common choice for dogs) (possible hypothyroidism at high dose), blood
performed unless cases are not responding ○ Clavulanic acid–potentiated amoxicillin dyscrasias
to appropriate antibiotic therapy. Findings 12.5-25 mg/kg PO q 12h • Benzoyl peroxide gel has to be used with
include intraepidermal neutrophilic pustules, ○ Clindamycin 5.5-11 mg/kg PO q 12h care because it may be irritating with
folliculitis, or furunculosis ± underlying ○ Cefovecin injectable 8 mg/kg SQ q 14 repeated use and causes fabric and hair
cause (e.g., Demodex, pemphigus foliaceus, days discoloration.
epitheliotrophic lymphoma, calcinosis cutis). • Other suggested drugs/dosages include • Drug-induced pemphigus foliaceus (beta-
• Endocrine status: thyroid function and (generally monotherapy, all PO) cefpodoxime lactams)
adrenal function tests may be warranted 5-10 mg/kg q 24h, oxacillin 22 mg/kg q 8h,
• Allergy testing: intradermal or serum allergy erythromycin 10-20/kg q 8h (vomiting and Recommended Monitoring
testing for environmental allergies, and diarrhea common), lincomycin 15-25 mg/ It is important to assess response to therapy
elimination diet trial for food allergy may kg q 12h, azithromycin 5 mg/kg q 24h, before the antibiotic course is completed to
be warranted. tylosin 10-20 mg/kg q 12h, trimethoprim- determine the appropriate duration of antibiotic
sulfadiazine 15-30 mg/kg q 12h, enrofloxacin administration and also to determine if there
TREATMENT 5-20 mg/kg q 24h (not in immature animals), is residual pruritus, which would suggest
marbofloxacin 2.75-5.5 mg/kg q 24h (not in underlying allergy, ectoparasite, or concurrent
Treatment Overview immature animals), pradofloxacin 3-4.4 mg/ Malassezia dermatitis.
The main goals are to treat the infection and kg q 24h (labeled for cats only in the United
determine the underlying cause(s). States), or doxycycline 5 mg/kg (day 1), then PROGNOSIS & OUTCOME
2.5 mg/kg q 12h
Acute General Treatment • Appropriate pain management • Superficial pyoderma: good prognosis as long
Topical therapy: as underlying factors are addressed adequately
• Topical therapy alone is a desirable approach Chronic Treatment • Deep pyoderma: some cases of deep pyo-
for most cases of surface pyoderma and many • In face of an idiopathic recurrent pyoderma derma result in scarring.
cases of superficial pyoderma (e.g., impetigo, (typically SBF) that recurs fewer than three • Affected animals are often immunosuppressed
mild or localized SBF) and to help prevent or four times per year, it is economical and or have other concurrent diseases.
recurrence of SBF while pursuing diagnostic reasonable to treat each event with an
procedures for primary underlying skin appropriate course of antibiotics. Repeated PEARLS & CONSIDERATIONS
disease. use of antibiotics increases the importance
• Chlorhexidine shampoos 2%-4% (typically for culture and susceptibility testing. p. 653. Comments
twice weekly) and/or daily chlorhexidine • In cases of idiopathic recurrent pyoderma in • Epidermal collarettes are extremely useful
2%-4% spray or wipes are most commonly which several episodes occur annually and/ secondary skin lesions to look for (clip some
used. or total annual antibiotic administration is hair if needed); they are strongly suggestive
• Shampoos containing benzoyl peroxide, ethyl > 12 weeks, adjunctive immunomodulatory of a superficial pyoderma.
lactate, and povidone-iodine may also be therapy or extended antibiotic regimens (both • Any therapeutic plan for controlling
used. controversial in veterinary dermatology) may pyoderma without considering underlying
• Topical antibiotics: mupirocin, fusidic acid be needed to maintain clinical remission. predisposing factors is destined to fail.
(Fucidin) most commonly used. Silver ○ Immunomodulatory therapy: Staphage • Most dermatologists use cephalexin as their
sulfadiazine and benzoyl peroxide 5% gels Lysate (SPL, Delmont Laboratories) first drug choice because it has been shown
are also available, as are nisin wipes. may decrease recurrences of pyoderma to be an effective drug against S. pseudin-
• Topical barrier membrane enhancing in up to 35% of dogs. The dog should termedius. However, there are increasing
products; ceramides initially receive a 4- to 6-week course concerns about emerging resistance. C&S
• Clip affected areas. of oral antibiotic in conjunction with a testing should be considered more frequently
• Deep pyoderma: bathe animal or soak lesion 20- to 30-week course of SPL (0.5 mL (p. 653).
with Epsom salts solution (magnesium twice weekly SQ). If the pyoderma does • Pemphigus foliaceus, calcinosis cutis, and
sulfate, 2 tablespoons/L of lukewarm water) not recur during that period, the frequency epitheliotrophic lymphoma may manifest as

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